Provider Demographics
NPI:1609242346
Name:GAGLIOTI, MELANIE M (DDS)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:M
Last Name:GAGLIOTI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:MARIE
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2955 SALVIO ST.
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519
Mailing Address - Country:US
Mailing Address - Phone:925-808-3456
Mailing Address - Fax:925-808-3455
Practice Address - Street 1:2955 SALVIO ST.
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519
Practice Address - Country:US
Practice Address - Phone:925-808-3456
Practice Address - Fax:925-808-3455
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA649061223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice